BEUDAMED
    FDA Adverse Event Summary report: N

    CHANG IOL FORCEPS

    MDR report key: 33887 · Received July 2, 1996

    Report

    Report Number
    MW1009424
    Date Received
    July 2, 1996
    Date of Event
    June 25, 1996
    Report Date
    June 28, 1996
    Manufacturer
    SYNERGETICS, INC.
    Product Code
    HNR
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MO, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    TIP OF INSTRUMENT BROKE OFF IN PT'S EYE DURING SURGERY. PORTION RECOVERED SUCCESSFULLY WITHOUT ANY DAMAGE TO PT'S EYE, USED IN REMOVAL OF OCULAR MEMBRANE. INSTRUMENT DESIGNED FOR IOL SURGERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CHANG IOL FORCEPS IOL FORCEPS HNR SYNERGETICS, INC. NA 5122687

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN